Before giving birth to your child, you might have expected sleepless nights, dirty diapers, and emotional ups and downs. What you might not have expected were terrifying, intrusive thoughts that seemed to come out of nowhere. Some of these thoughts might look like images of accidentally dropping your baby down the stairs or of harming your newborn. Many women who experience these thoughts and images find themselves paralyzed by shame and fear, and as a result, tell no one.
While mental health struggles during the perinatal period (pregnancy through the first year postpartum) are increasingly recognized and discussed, one particularly distressing condition remains largely in the shadows: Perinatal Obsessive-Compulsive Disorder (OCD). Unlike general postpartum anxiety or depression, perinatal OCD is characterized by intrusive, unwanted thoughts and compulsive behaviors aimed at reducing the anxiety or fears (IAPMD, 2019). Despite how frightening its symptoms can be, perinatal OCD is both treatable and more common than many realize.
What is perinatal OCD?
Perinatal Obsessive-Compulsive Disorder is a specific form of OCD that can emerge during pregnancy or after childbirth. While many new parents experience heightened worry or anxiety, perinatal OCD involves a far more intense and debilitating cycle. It’s defined by persistent, unwanted intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to prevent a feared event or reduce anxiety (Hudak & Wisner, 2012).
What sets perinatal OCD apart from general OCD is the nature of the obsessions, which often center around the infant’s safety and wellbeing. Common themes include fears of contamination, accidental harm, or even violent or sexual thoughts involving the baby — thoughts that are horrifying to the parent, who would never want to act on them (Hudepohl et al, 2022).
According to Hudepohl et al (2022), these thoughts are ego-dystonic, meaning that they are deeply upsetting to parents who experience them. Having these thoughts does not reflect a parent’s values or intentions, and thinking these things does not mean they want to hurt their baby. In fact, parents with perinatal OCD are often the most cautious and caring, which is part of why these thoughts feel so terrifying—they go completely against how you actually feel. This is a key distinction from conditions like postpartum psychosis, where there may be a detachment from reality and a lack of insight, potentially compelling a parent struggling with this mental condition to act out their thoughts (Hudepohl et al, 2022). Parents with perinatal OCD are aware that their thoughts are irrational — and that insight often increases their distress.
Despite how isolating it can feel, perinatal OCD affects an estimated 2.43-9% of new mothers, typically beginning within the first eight weeks of childbirth, but can begin anytime within the first year post childbirth (Ferra et al, 2024). Also according to Ferra et al (2024), fathers and non-birthing partners can also experience perinatal OCD, though this remains underreported and under-researched.
What is it like to have perinatal OCD?
Imagine holding your newborn baby and suddenly being struck by an intrusive thought: “What if I drop the baby?” Or walking into the kitchen and feeling a jolt of panic at the sight of a knife, accompanied by the thought, “What if I lose control and hurt my baby?” For some, the thoughts may be even more taboo—“What if I sexually harm my baby?” These thoughts, though horrifying and deeply unsettling, are common within the context of perinatal OCD.
The emotional impact of these thoughts can be devastating. Parents often experience overwhelming guilt, shame, fear, and a persistent anxiety that they are “monsters” or unfit to care for their child. If these fears are extreme, they can also lead to debilitating avoidance. For example, a mother who worries about dropping her child out the window may begin to avoid all windows or the woman who has images of her child being stabbed may refuse to use knives or enter the kitchen.
Most compulsions and avoidances do not directly harm the child, but in extreme cases, they can, if they lead to avoidance of the baby for fear of harming them (Hudak & Wisner, 2012). According to Challacombe et al (2016), even when symptoms aren’t severe, they can still impair the parent-child relationship, contributing to attachment difficulties and emotional strain. This makes it all the more important to seek treatment—though, unfortunately, that doesn’t always happen.
Because of the intense stigma surrounding these experiences, many individuals hide their symptoms, even from loved ones or healthcare providers. They may fear their child will be taken away or that others will see them as dangerous or unfit to be a parent. This silence only deepens the isolation and distress, which can delay critical intervention and support.
What’s crucial to understand is that these intrusive thoughts are a symptom, not a reflection of intent. They are no more dangerous than the fleeting mental images anyone might experience under stress and there is not an elevated risk of aggressive harm to their infants (Hudak & Wisner 2012). Recognizing and destigmatizing these thoughts is the first step toward healing.
How might I get help if I experience perinatal OCD?
The good news is that perinatal OCD is highly treatable. With the right combination of therapy, support, and sometimes medication, you can reclaim your sense of peace and feel more confident in your role as a parent.
The treatment of perinatal OCD typically conducted in a similar manner as for general OCD. The first line of treatment is often Cognitive Behavioral Therapy (CBT) with Exposure Response Prevention (ERP) (Hudak et al, 2012). While that may sound a bit clinical, here’s what it really means: with the help of a trained therapist, parents gently and gradually face the thoughts or situations they fear—without doing the usual compulsive behaviors that try to ‘cancel out’ the fear.
For example, if you find yourself constantly checking on your baby to make sure they’re okay, ERP might involve practicing being alone with your baby without checking, and allowing yourself to sit with the discomfort. Over time, your brain learns that the feared outcome doesn’t happen, and the anxiety starts to fade (Hudak & Wisner, 2012). Bit by bit, you can begin to feel safer, more in control, and more like yourself again.
While CBT with ERP is the first line approach to treatment, other forms of therapy can also be useful in navigating perinatal OCD, including: individual supportive therapy, family therapy & couples therapy. These additional forms of support can help alleviate distress caused by perinatal OCD and can improve communication and coping among loved ones (Koran et al, 2007). When symptoms are so severe that parents cannot engage in or benefit from therapy, medication may be needed.
According to Hudepohl et al (2022), Some of the most commonly used medications for OCD are SSRIs (selective serotonin reuptake inhibitors). These include medications like Prozac (fluoxetine), Zoloft (sertraline), Luvox (fluvoxamine), and Paxil (paroxetine). Another option is clomipramine, a different type of antidepressant that can also be helpful. These medications are considered the first choice for treating OCD. While most of the research on these medications has been done in people who aren’t pregnant, the studies that do focus on pregnancy and postpartum show that the medications work just as well during this time (Sharma et al, 2015).
Usually, treatment lasts for about 1 to 2 years before thinking about tapering off—this recommendation stays the same whether you’re pregnant, postpartum, or not. The side effects of these medications tend to be mild, and the benefits can make a big difference in your daily life (Sharma et al, 2015), though you will of course want to consult with your doctor to see if medication is the right path for you.
Peer support and community are also a vital part of treatment. Organizations like Postpartum Support International offer support groups, helplines, and resources tailored to parents experiencing perinatal OCD. Knowing that you are not alone—and that others have walked this path and recovered—can provide a powerful sense of hope and validation.
Most importantly, you should know that recovery is absolutely possible. With the right tools and support, intrusive thoughts lose their grip, and peace can be restored.
Breaking the silence
One of the most important things to know is this: intrusive thoughts do not make you a bad parent. They aren’t signs that something is wrong with you—they’re signs of a treatable mental health condition. These thoughts can feel incredibly scary and unsettling, but they are not a reflection of who you are. They don’t define your love, your intentions, or your ability to care for your child.
Perinatal OCD is a silent struggle for many, but it doesn’t have to be. With increased awareness and access to care, relief is absolutely possible. You can feel like yourself again. You can enjoy parenthood without being overwhelmed by fear.
The first step? Feeling safe enough to speak up. When parents are met with understanding—not judgment—that’s when true healing begins.
You are not alone. You are not failing. And you absolutely can get better.
Help is available, and there is no shame in reaching for it. If you are struggling with perinatal OCD or any other mental health challenges during pregnancy or postpartum, Wildflower therapists are available to support you with compassion, expertise, and evidence-based care. Contact us to learn more. If you would like to read more about mental health during the transition to parenthood, we invite you to check out our free Pregnancy and Postpartum Mental Health Guide.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Challacombe, F., Salkovskis, P.M., Woolgar, M., Wilkinson, E.L., Read, J., Acheson, R (2016). Parenting and mother-infant interactions in the context of maternal postpartum obsessive-compulsive disorder: Effects of obsessional symptoms and mood. Infant Behavior and Development, 44, 11-20. https://doi.org/10.1016/j.infbeh.2016.04.003
Hudak, R., & Wisner, K. L. (2012). Diagnosis and treatment of postpartum obsessions and compulsions that involve infant harm. The American Journal of Psychiatry, 169(4), 360–363. https://doi.org/10.1176/appi.ajp.2011.11050667
Hudepohl, N., MacLean, J. V., & Osborne, L. M. (2022). Perinatal obsessive-compulsive disorder: Epidemiology, phenomenology, etiology, and treatment. Current Psychiatry Reports, 24(4), 229–237. https://doi.org/10.1007/s11920-022-01333-4
Inês Ferra, Miguel Bragança & Ricardo Moreira (2024). Exploring the clinical features of postpartum obsessive-compulsive disorder- a systematic review. The European Journal of Psychiatry, 38(1), https://doi.org/10.1016/j.ejpsy.2023.100232
Koran, L. M., Hanna, G. L., Hollander, E., Nestadt, G., Simpson, H. B., & American Psychiatric Association (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. The American Journal of Psychiatry, 164(7 Suppl), 5–53.
Sharma V, Sommerdyk C (2015) . Obsessive–Compulsive disorder in the postpartum period: Diagnosis, differential diagnosis and management. Women’s Health, 11(4):543-552. https://doi.org/10.2217/WHE.15.20
